Mindfulness Prevents Depression and Psychopathology in Elderly People with Mild to Moderate Alzheimer's Disease: A Randomized Clinical Trial.

BACKGROUND: This longitudinal study addressed whether mindfulness practice prevents psychological and behavioral symptoms, especially mood disorders, in Alzheimer's disease (AD). OBJECTIVE: To assess the incidence of depression in the course of AD and to determine which non-pharmacological treatment (NPT) is most effective in preventing psychopathological symptoms. METHODS: We conducted a longitudinal, non-inferiority and equivalence randomized clinical trial, repeated-measures design, with a control group and three experimental treatments: mindfulness, cognitive stimulation, and relaxation. Each experimental group performed three weekly sessions for two years. The pharmacological treatment of all participants was donepezil (10 mg). Participants were patients with probable AD without diagnosed depression from the public neurology services of the Canary Health Service, Spain. Psychological evaluation was performed using the Geriatric Depression Scale (GDS), Hamilton Depression Rating Scale (HDRS), and Neuropsychiatric Inventory (NPI-Q). The statistical analysis included only patients who attended at least 75% of the sessions. A nonparametric, repeated-measures analysis was performed with Kruskal-Wallis H test and between-group differences with Mann-Whitney U test with Bonferroni correction (p < 0.008). Effect size was calculated with partial eta-squared. RESULTS: The results showed significant differences with large effect sizes (η2p>0.14) between mindfulness and the rest of the experimental groups as well as the control in the GDS, HDRS, and NPI-Q scales. CONCLUSION: Compared to the other experimental groups, only mindfulness prevented the onset of depression and other psychopathologies in early-stage AD. Based on its effectiveness in maintaining cognitive functions and preventing psychopathology, we recommend mindfulness as the first-choice NPT for mild to moderate AD.

Effect of 'Exercise Without Movement' yoga method on mindfulness, anxiety and depression.

OBJECTIVE: To analyze the effect of the 'Exercise Without Movement' (E.W.M) yoga method on mindfulness and on the improvement of anxiety and depression symptoms. METHODS: A quasi-experimental study examined the effect of one month E.W.M. intervention among 38 participants who were enrolled voluntarily to both groups, study (n = 16) and control (n = 22). Five participants dropped out during the study. The State Mindfulness Scale (SMS) was used to measure mindfulness. The Anxiety Inventory Beck (BAI) and the Beck Depression Inventory (BDI-II) were used to measure the anxiety and depression symptoms, respectively, before and after the intervention. RESULTS: Study group showed both a statistically significant increase in mindfulness and decrease in anxiety and depression symptoms, compared with the control group. CONCLUSIONS: The E.W.M. has been useful in the development of mindfulness and in the treatment of anxiety and depression symptoms and may represent a new method in the mindfulness-based therapeutic application.

Mindfulness in the Maintenance of Cognitive Capacities in Alzheimer's Disease: A Randomized Clinical Trial.

BACKGROUND: The Canary Islands longitudinal study on non-pharmacological treatments showed the overall effectiveness of mindfulness in Alzheimer's disease (AD). However, no specific data on the maintenance of cognitive capacities were presented. OBJECTIVE: To determine whether the practice of mindfulness modifies the course of cognitive impairment in AD. DESIGN: Longitudinal, non-inferiority and equivalence, randomized clinical trial, repeated-measures design, with three experimental groups and one control group. PARTICIPANTS: Patients with AD who voluntarily attended the Lidia García Foundation (n = 502). Only those who were treated with donepezil and MMSE ≥18 were included (n = 120). INTERVENTION: Over a two-year period, each group carried out three weekly sessions of stimulation based on mindfulness, cognitive stimulation therapy, and progressive muscle relaxation. MEASURES: Cognitive assessment CAMDEX-R (MMSE and CAMCOG). STATISTICAL ANALYSIS: Repeated-measures ANOVA (p <  0.05) and the effect size Cohen's d were performed. RESULTS: The mindfulness group showed significant scores compared with the control and muscle relaxation groups (p <  0.05), while mindfulness and cognitive stimulation therapy were equivalent (p≥0.05). Group cognitive stimulation evolved better than the control (p <  0.05) group but not better than the muscle relaxation group (p≥0.05). The effect size compared over two years was large for the mindfulness group (p≥0.80), moderate for the relaxation group (p≥0.50), and low for the cognitive stimulation group (p≥0.20). CONCLUSION: The practice of mindfulness maintained cognitive function over a period of two years. This longitudinal study suggests that mindfulness can be used as a non-pharmacological treatment to slow cognitive impairment in AD.

Estimulación basada en mindfulness en la enfermedad de Alzheimer avanzada: ensayo clínico piloto comparativo de equivalencia / Mindfulness-based stimulation in advanced Alzheimer's disease: a comparative, non-inferiority, clinical pilot study

Introducción. Se llevó a cabo un estudio longitudinal para analizar la viabilidad, la seguridad y los efectos de la práctica de mindfulness, relajación y estimulación cognitiva en la evolución clínica de la enfermedad de Alzheimer (EA) con el objetivo de analizar la equivalencia de estos tratamientos. Material y métodos. En el estudio participaron 168 personas con EA probable en tratamiento con donepezilo. En este artículo se muestra a los 21 participantes en estadio grave que completaron el seguimiento de 24 meses. Se agrupó a los sujetos en 3 grupos experimentales (estimulación cognitiva, relajación y mindfulness) y uno control. Cada grupo desarrolló 3 sesiones semanales con medidas semestrales de seguimiento (cognición: CAMCOG y MMSE; funcionalidad: RDRS-2; psicopatología: NPI). Se realizaron análisis no paramétricos. Resultados. Las puntuaciones de la función cognitiva y la funcionalidad indicaron que no existían diferencias significativas entre los diferentes grupos. No obstante, los grupos de mindfulness y estimulación cognitiva no perdieron puntuación en la capacidad cognitiva en el análisis intragrupo. En el NPI se produjeron diferencias entre el grupo de mindfulness y el control al final del estudio (p < 0,017). Conclusión. Los datos muestran que el tratamiento de donepezilo con mindfulness o estimulación cognitiva presenta una mejor evolución clínica que el tratamiento farmacológico solo o combinado con relajación. Estos datos indican que se debe seguir trabajando en nuevas alternativas terapéuticas para la EA avanzada y que los tratamientos no farmacológicos deben ser recomendados en la práctica clínica para el control evolutivo de la enfermedad a largo plazo. Ensayos con un mayor número de participantes son necesarios para confirmar los resultados informados en este estudio (AU)

Introduction. A longitudinal study was conducted in order to analyze the feasibility, safety, and effects of the practice of mindfulness, relaxation and cognitive stimulation on the evolution of Alzheimer's disease, with the aim of testing the equivalence of these interventions. Material and methods. There were a total of 168 participants with probable Alzheimer's disease (AD) treated with donepezil. In the present article, the 21 participants with advanced AD who completed a follow-up period of 24 months are presented. The participants were grouped into three experimental groups (mindfulness, relaxation, and cognitive stimulation) and one control group. Each group carried out three weekly sessions with bi-annual follow-up measurements (cognition: CAMCOG and MMSE; functionality: RDRS; psychopathology: NPI). Non-parametric analyses were performed. Results. The cognitive function and functionality scores showed no significant differences between the groups. However, the scores in cognitive function of the mindfulness group and the cognitive stimulation group did not decrease in an intra-group analysis. In NPI, there were significant differences between the mindfulness group and the control group by the end of the study (P<.017). Conclusion. The data showed that the treatment with donepezil in combination with mindfulness or cognitive stimulation presented a better clinical evolution than the pharmacological treatment alone or combined with relaxation. These data suggest that these therapeutic alternatives should be investigated further, and that the non-pharmacological treatments should be recommended in clinical practice in order to control the evolution of AD in the long term. In order to confirm these findings, a larger study is necessary (AU)

[Mindfulness-based stimulation in advanced Alzheimer's disease: A comparative, non-inferiority, clinical pilot study]. / Estimulación basada en mindfulness en la enfermedad de Alzheimer avanzada: ensayo clínico piloto comparativo de equivalencia.

INTRODUCTION: A longitudinal study was conducted in order to analyze the feasibility, safety, and effects of the practice of mindfulness, relaxation and cognitive stimulation on the evolution of Alzheimer's disease, with the aim of testing the equivalence of these interventions. MATERIAL AND METHODS: There were a total of 168 participants with probable Alzheimer's disease (AD) treated with donepezil. In the present article, the 21 participants with advanced AD who completed a follow-up period of 24 months are presented. The participants were grouped into three experimental groups (mindfulness, relaxation, and cognitive stimulation) and one control group. Each group carried out three weekly sessions with bi-annual follow-up measurements (cognition: CAMCOG and MMSE; functionality: RDRS; psychopathology: NPI). Non-parametric analyses were performed. RESULTS: The cognitive function and functionality scores showed no significant differences between the groups. However, the scores in cognitive function of the mindfulness group and the cognitive stimulation group did not decrease in an intra-group analysis. In NPI, there were significant differences between the mindfulness group and the control group by the end of the study (P<.017). CONCLUSION: The data showed that the treatment with donepezil in combination with mindfulness or cognitive stimulation presented a better clinical evolution than the pharmacological treatment alone or combined with relaxation. These data suggest that these therapeutic alternatives should be investigated further, and that the non-pharmacological treatments should be recommended in clinical practice in order to control the evolution of AD in the long term. In order to confirm these findings, a larger study is necessary.

Efectos de un programa de intervención neuropsicológica basado en mindfulness sobre la enfermedad de Alzheimer: ensayo clínico aleatorizado a doble ciego / Effects of a neuropsychology program based on mindfulness on Alzheimer's disease: randomized double-blind clinical study

Introducción. Evaluar los efectos de un programa de intervención neuropsicológica basado en mindfulness en la evolución clínica de la enfermedad de Alzheimer. Material y método. Se realizó un ensayo clínico aleatorizado de dos años de duración a doble ciego. En el estudio participaron 127 personas mayores con enfermedad de Alzheimer probable según criterios de la NINCDS-ADRDA. Se agruparon los enfermos en tres grupos experimentales (estimulación cognitiva, relajación muscular progresiva y mindfulness) y un grupo control. Todos los enfermos estaban en tratamiento con donepezilo. Se evaluaron las capacidades cognitivas con el CAMCOG y MMSE, el área funcional con el RDRS-2 y el área psicopatológica con el NPI. Se desarrollaron tres sesiones a la semana durante 2 años con medidas semestrales de seguimiento. Resultados. Las mediciones de la función cognitiva global, la funcionalidad y los trastornos de conducta asociados a la demencia indicaron que los enfermos del grupo experimental basado en mindfulness se han mantenido estables durante los dos años, mientras que los controles y el resto de los grupos experimentales muestran un leve pero significativo empeoramiento de sus capacidades mentales. Conclusión. El programa de intervención neuropsicológica basado en mindfulness se ha asociado con la estabilidad cognitiva y funcional y mejoras significativas en la situación psicopatológica de los enfermos de Alzheimer en fase leve y moderada. Estos resultados apoyan la idea de que la intervención basada en mindfulness puede producir un beneficio clínicamente relevante en el tratamiento de la demencia. Se debe seguir trabajando en esta línea para confirmar estos datos (AU)

Introduction. The purpose of this research was to assess effects of a mindfulness based neuropsychological intervention on the clinical course of Alzheimer's disease. Material and method. A two year randomized and double blind clinical trial was conducted on 127 probable Alzheimer's disease patients, according to NINCDS-ADRDA scale. Patients were grouped into three experimental groups (cognitive stimulation, progressive muscular relaxation, and mindfulness) plus a control group. All participants were receiving donepezil. Cognitive skills were assessed with CAMCOG and MMSE, functional area with RDRS-2, and NPI was used for psychopathology screening. Three treatment sessions per week were carried out for two years, and follow up measurements were taken every six months. Results. The global cognitive function, functionality and behavioral disorders measurements indicated that patients from the experimental group based on mindfulness were stable during the two years, while patients from the control group, as well as the other experimental groups, showed a mild but significant worsening of their mental capacities. Conclusion. The mindfulness based neuropsychological program showed better cognitive and functional stability, as well as significant improvement in the psychopathological condition of mild to moderate Alzheimer’ patients. These results support the idea that a mindfulness based intervention can produce a clinically relevant improvement in the treatment of dementia. More research is needed to confirm these data (AU)

[Effects of a neuropsychology program based on mindfulness on Alzheimer's disease: randomized double-blind clinical study]. / Efectos de un programa de intervención neuropsicológica basado en mindfulness sobre la enfermedad de Alzheimer: ensayo clínico aleatorizado a doble ciego.

INTRODUCTION: The purpose of this research was to assess effects of a mindfulness based neuropsychological intervention on the clinical course of Alzheimer's disease. MATERIAL AND METHOD: A two year randomized and double blind clinical trial was conducted on 127 probable Alzheimer's disease patients, according to NINCDS-ADRDA scale. Patients were grouped into three experimental groups (cognitive stimulation, progressive muscular relaxation, and mindfulness) plus a control group. All participants were receiving donepezil. Cognitive skills were assessed with CAMCOG and MMSE, functional area with RDRS-2, and NPI was used for psychopathology screening. Three treatment sessions per week were carried out for two years, and follow up measurements were taken every six months. RESULTS: The global cognitive function, functionality and behavioral disorders measurements indicated that patients from the experimental group based on mindfulness were stable during the two years, while patients from the control group, as well as the other experimental groups, showed a mild but significant worsening of their mental capacities. CONCLUSION: The mindfulness based neuropsychological program showed better cognitive and functional stability, as well as significant improvement in the psychopathological condition of mild to moderate Alzheimer' patients. These results support the idea that a mindfulness based intervention can produce a clinically relevant improvement in the treatment of dementia. More research is needed to confirm these data.

Zung scale factor invariance in male coronary patients and healthy people

The objective of this study was, firstly, to determine the factor structure and factor invariance of the Zung Self-Rating Depression Scale (ZSDS) and, secondly, to justify its use in coronary patients (CPs) and healthy people (HP). Two comparable samples of males were studied: 217 CPs and 191 HP. Exploratory and confirmatory factor analyses (EFA and CFA) for ordinal data were carried out with Mplus. Two models obtained from all participants in this study and another two, the model of Shafer (2006) from a meta-analysis and that of Barefoot et al. (2000) with CPs, were analyzed in CFA. A two-factor structure was supported by EFA in both samples, but none of the models showed adequate goodness-of-fit for the CPs and the HP in CFA. Only the two and three-factor models obtained from the combined sample of CPs and HP showed adequate goodness-of-fit for HP. The ZSDS showed good reliability, replicated the prevalence of depressive symptoms found in other studies and was able to distinguish between CPs and HP. We conclude that the best fit is obtained from the two-factor solution in HP, that the factor structure of the ZSDS is not invariant and is linked to positively and negatively worded items (AU)

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Modelos factoriales del Inventario de Depresión de Beck-II. Validación con pacientes coronarios y una crítica al modelo de Ward / Factor models of the Beck Depression Inventory-II. Validation with coronary patients and a critique of

El objetivo del estudio era validar en una muestra de 205 enfermos coronarios un modelo factorial para el BDI-II, especialmente un modelo que permitiera modelar los síntomas depresivos tras eliminar explícitamente el sesgo asociado a los síntomas somáticos que pueden confundirse con síntomas de la enfermedad. Se realizaron análisis factoriales exploratorios y confirmatorios para datos ordinales. Se analizan un modelo monofactorial, seis modelos con dos factores correlacionados y, derivados de éstos, siete modelos con un factor general y dos factores no correlacionados. El análisis exploratorio aísla dos factores, somático-afectivo y cognitivo. En los análisis confirmatorios, el modelo monofactorial obtiene el peor ajuste. Los modelos bifactoriales son superados en bondad de ajuste por los modelos de factor general y de grupo. Entre éstos destaca el modelo General, Somático-afectivo y Cognitivo (G-Sa-C) de Beck con estudiantes. El peor el General, Somático, Cognitivo (G-S-C) reducido de Ward. Nuestro modelo supera los puntos de corte de todos los índices de ajuste. Se concluye que la inclusión de factores generales y de grupo en todos los modelos supera los resultados del modelo G-S-C y, por tanto, lo cuestiona. El modelo G-Sa-C resulta fortalecido (AU)

The objective of this study was to validate in a sample of 205 coronary patients a factor model for the BDI-II, especially a model that would allow for modeling of depressive symptoms after explicitly removing bias related to somatic symptoms of depression that would overlap those of heart disease. Exploratory and confirmatory factor analyses for ordinal data were conducted. A one-factor model, six correlated two-factor models and, derivatives thereof, seven models with a single General Depression factor and two uncorrelated factors, were analyzed. Exploratory analysis extracted two factors, Somatic-affective and Cognitive. Confirmatory factor analyses showed the worst fit for the one-factor model. Two-factor models were surpassed in goodness of fit by the models of general-factor and group factors. Among these, the General, Somatic-affective and Cognitive (G-Sa-C) model of Beck with students is noteworthy. The reduced General, Somatic and Cognitive (G-S-C) model of Ward showed the worst goodness of fit. Our model surpasses the cutoff criteria of all fit indexes. We conclude that the inclusion of a general-factor and group factors in all the models surpasses the results of G-S-C model and, therefore, questions it. The G-Sa-C model is strengthened (AU)

[Factor models of the Beck Depression Inventory-II. Validation with coronary patients and a critique of Ward's model]. / Modelos factoriales del Inventario de Depresión de Beck-II. Validación con pacientes coronarios y una crítica al modelo de Ward.

The objective of this study was to validate in a sample of 205 coronary patients a factor model for the BDI-II, especially a model that would allow for modeling of depressive symptoms after explicitly removing bias related to somatic symptoms of depression that would overlap those of heart disease. Exploratory and confirmatory factor analyses for ordinal data were conducted. A one-factor model, six correlated two-factor models and, derivatives thereof, seven models with a single General Depression factor and two uncorrelated factors, were analyzed. Exploratory analysis extracted two factors, Somatic-affective and Cognitive. Confirmatory factor analyses showed the worst fit for the one-factor model. Two-factor models were surpassed in goodness of fit by the models of general-factor and group factors. Among these, the General, Somatic-affective and Cognitive (G-Sa-C) model of Beck with students is noteworthy. The reduced General, Somatic and Cognitive (G-S-C) model of Ward showed the worst goodness of fit. Our model surpasses the cutoff criteria of all fit indexes. We conclude that the inclusion of a general-factor and group factors in all the models surpasses the results of G-S-C model and, therefore, questions it. The G-Sa-C model is strengthened.